Treatment of uterine fibroids without surgery - 3 modern methods
Content:
- Uterine artery embolization (UAE)
- FUS-ablation of uterine fibroids
- Exercises for uterine fibroids according to the method of Bubnovsky
Myoma of the uterus is a benign tumor that forms from the muscle layer of an organ and mainly consists of connective tissue elements. This formation is treatable. Modern medicine has the latest methods of eliminating pathology with minimal losses for women's health.
Uterine artery embolization (UAE)
One of the modern methods of treatment of fibroids is uterine artery embolization. This is a minimally invasive technique that allows you to remove the tumor in a non-surgical way.
What is uterine artery embolization?
Embolization of the uterine arteries is one of the modern methods of treating fibroids without surgery. The therapeutic effect is achieved due to the fact that the fibroid nodes cease to receive nutrients delivered through the blood. This is due to the blockage of the blood supply to the tumor.
It should be noted that this method is considered to be fundamentally new in Russia, while in most countries of the world it has been successfully used since the beginning of the 70s of the last century. Although at first embolization was used to stop bleeding during the operation, and then it was transformed into an independent method of treatment. Permission for embolization as an endovascular procedure was obtained in the Russian Federation in 1998. Naturally, against the background of a previously used surgical operation aimed at removing the uterus along with myoma, this method is considered innovative.
The very word embolization already implies selective occlusion or blockage of blood vessels through the introduction of emboli (unbound intravascular substrate). For the treatment of fibroids, small balls are used, which come together with the injected drug. As a result, the fibroid dies within a few hours, as its arteries are blocked. The doctor who performs this technique is called an X-ray surgeon (interventional radiologist, endovascular surgeon). For its implementation, it is necessary that the clinic be equipped with special angiographic equipment and an X-ray operating room.
This technique makes it possible to refuse the removal of the uterus when a fibroid is detected and the need to make incisions in the abdominal cavity. That is, a woman does not lose her reproductive function, and after completing the rehabilitation process, she will be able to return to a full life and conceive a child.
Indications for embolization
In order for uterine artery embolization to be prescribed, a woman needs to be examined by a gynecologist.
The indications for conducting are:
- Fibroids that do not exceed 20 weeks of gestation. If the formation is larger, embolization is not possible.
- Absence of pathological processes in the cervix, in the endometrial layer and in the ovaries.
- Woman's desire to have children in the future.
- Influence of fibroids on infertility in establishing this connection.
- When myoma influences the inability to bear a child, when the tumor becomes the cause of miscarriages.
- The impossibility of carrying out a myomectomy that is safe for a woman's health.
- Preparation for the upcoming myomectomy or surgery to remove the uterus along with myoma.
- Large nodes of multiple fibroids.
- Amyloidosis of the vessels of the uterus.
A woman's desire to preserve her reproductive function has a significant impact on the procedure.
Contraindications to uterine artery embolization
Like any other type of minimally invasive intervention, embolization has not only indications, but also contraindications for its implementation.
Among them:
- The size of the uterus with fibroids exceeds 20 weeks of pregnancy.
- Oncological diseases.
- Pregnancy.
- Any active inflammatory and infectious processes in the vagina or ovaries.
- Obstruction of the iliac arteries and their branches.
- Renal failure
- Blood clotting disorders.
- Submucous myoma on the pedicle, but at the same time it should be single. In the presence of multiple submucous myomas, one of which will be pedunculated, embolization can be performed.
- Allergic reaction to contrast agents that will be used for embolization.
In addition, subserous nodes larger than 10 cm in size, the blood flow inside which is weakened, can become a relative contraindication.
Mechanism of action
Before the procedure is performed, a woman needs to go through a small preparatory stage. It boils down to the fact that on the day of hospitalization, you should refuse to eat. The groin and thigh should be hairless, for which it is worth using a razor. It is possible to apply elastic bandages on both legs just before the procedure.
The patient is brought into the office and placed on the angiographic table. The abdomen and thigh are treated with antiseptic solutions. Through a puncture (its size does not exceed 1.5 mm), which is performed in the area of the inguinal fold, a catheter tube (its diameter is not more than 1.2 mm) is inserted into the femoral artery. Local anesthesia is used to relieve pain because the procedure is not too painful. Most often, either novocaine or lidocaine is used for this. Under X-ray control, the doctor inserts a catheter into the uterine artery, up to the point where it begins to branch out and feed the fibroids.
An arteriogram is done to make sure the catheter is positioned correctly and to confirm the fibroid. That is, a special contrast agent is inserted into the catheter, which can be seen with an X-ray. After making sure that everything is done correctly, the surgeon begins the introduction of emboli into the artery. Their role is played either by the smallest particles of a gelatinous sponge, or plastic balls made of polyvinyl alcohol or polyurethane foam.
After the emboli reach the narrow vessels, they stop there, blocking them. Therefore, the blood can no longer flow to the tumor tissues and its nutrition is disrupted.
To completely deprive myoma of nutrition, a similar procedure is performed on the second femoral artery. Then the surgeon performs an arteriogram again, the purpose of which is to exclude the slightest possibility of feeding the tumor.
The site that was punctured is closed with a sterile patch. In addition, a pressure bandage is applied to the thigh. After 12 hours, it is removed and the embolization is considered complete. Then the woman will have to go through a recovery period.
During the technique, a woman may experience a sensation of warmth in the legs and lower abdomen. The average embolization time is 15 minutes. Although the duration depends on the depth of the nodes, on their number and can be up to half an hour.
Results of uterine artery embolization
The result of the embolization is the resorption of the fibroid. It continues to actively decrease in size during the first half of the year. Although in the future there is a tendency to decrease it. As statistics show, 12 months later, after the embolization, the size of the tumor becomes 4 times smaller. At the same time, the uterus itself acquires normal volumes.
Sometimes the result of embolization can be the exit of tumor nodes through natural pathways. This is especially often observed when they are close to the uterine cavity. Such expulsion of fibroids is considered the most favorable outcome of the procedure, since the fastest recovery of all damaged structures occurs.
The woman's pain disappears, the menstrual cycle normalizes, the volume of discharge decreases. Moreover, these are early qualitative characteristics of the procedure performed.
The fibroid itself is replaced by connective tissues.
Benefits of Uterine Artery Embolization
This procedure for getting rid of the tumor has undoubted advantages over other methods of treatment.
They boil down to the fact that:
- There is no risk of disease recurrence. This is due to the fact that during embolization, the arteries of all nodes are clogged, regardless of their size. That is, even the smallest fibroids will stop receiving nutrition and die. Statistics indicate that 98% of patients who have undergone embolization do not require further treatment at all. With any surgical intervention, it is impossible to achieve such indicators.
- After the procedure, there will be no visible scars or scars on the woman's body.
- In the process of execution, the introduction of general anesthesia is not required. The procedure is practically painless. This means that the body will not be subject to additional stress and will not need to recover from global anesthesia.
- After embolization, the patient does not need to be in the hospital for a long time. Doctors recommend staying under supervision for two more days. However, many women leave the clinic after a few hours on the same day.
- The technique is applicable to those women who have contraindications for surgical intervention.
- A woman does not lose the opportunity to have children in the future.
That is why the procedure is becoming more and more popular every year and more and more clinics in the country offer to perform it.
Postembolization period
When the procedure is complete, the woman will need to return to the ward. The puncture site is cooled with ice. Sometimes a dropper may be required. After a couple of hours, the woman will begin to experience unpleasant pulling sensations, sometimes quite painful. The place of their localization is the lower abdomen. They are due to the fact that the fibroid begins to experience bouts of ischemia. Such sensations last for several hours and, if necessary, will be stopped by painkillers.
At the puncture site, where the catheter was inserted, you can observe a hematoma, which disappears over time. During the first 12 hours, a woman will not be able to bend her right limb; if a pressure bandage was applied, it will be removed after two hours.
In addition, an increase in body temperature is possible during the psotembolization period. Typically, the thermometer does not show a reading above 37.5 degrees. Sometimes the accompanying symptoms are dizziness, weakness, nausea. You should not be afraid of this, since such companions of the early rehabilitation period quickly pass and do not threaten the patient's health.
After a couple of days, the woman goes home, but she will need to refrain from physical activity for a week.
The following guidelines will help the patient go through the later rehabilitation period without complications:
- The amount of fluid you drink should be increased, which is the prevention of vascular blockage.
- Sometimes it is possible to take acetylsalicylic acid, as a means that can thin the blood.
- In some cases, doctors recommend wearing elastic bandages on the legs for a week.
- You cannot visit the bath, sauna, steam room, bathhouse or swimming pool in the first week after the operation.
- Sexual rest should be observed during the first 10 days after the procedure.
- In the next three months, it is forbidden to use tampons during menstruation. For hygienic purposes, only pads can be used.
Thus, the post-embolization period passes and it takes no more than 10 days.
Side effects and complications
Although the procedure is considered safe enough, there is still a risk of side effects. However, they are much lower than after surgery and develop in isolated cases.
Among the most common complications, the following can be noted:
- The appearance of a hematoma in the area of the puncture. As a rule, it resolves itself after a week.
- Disorders of the menstrual cycle, which occurs in 3% of cases. Sometimes amenorrhea may develop. But these phenomena are temporary and after 3 months, and sometimes even earlier, they pass.
- Infection is possible only in 1% of cases. If inflammation develops, then it is eliminated by taking antibacterial drugs. Cases of performing a hysterectomy to eliminate the infectious process are extremely rare.
- Even less often, particles used for embolization enter the vascular pool. This complication is a threat to the woman's life and requires surgical intervention.
- If submucous fibroids have been treated, then there is a risk of new nodes. As a rule, their birth is possible in 20% of cases.
- Perforation of the uterine arteries is a rare but possible complication of the procedure.
- A woman should know that during the next year she should not plan a pregnancy, as this threatens a high risk of miscarriage.
A woman should be aware of all possible complications and consequences of the procedure by the attending physician. This must be done also because surgery may be required before the embolization procedure is completed.
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FUS-ablation of uterine fibroids
FUS ablation is a non-invasive procedure in which fibroids are treated using focused ultrasound. All the doctor's actions are carried out under the control of a magnetic resonance imager.
Ultrasound waves act precisely on the tumor. At the same time, the woman is inside the tomograph. Before starting the procedure, the doctor scans the uterus and precisely determines the place that needs to be treated. After that, the section of the fibroid is heated under the influence of a beam of ultrasonic waves and its tissues are destroyed.
In the Russian Federation, this method has been approved for use for the treatment of fibroids since 2004 and is a relatively young procedure. However, this does not affect its effectiveness in any way.
Preparation for FUS ablation of uterine fibroids
As for the preparation for the procedure, it is important to clarify the absence of contraindications and exclude pregnancy. There is no ban on eating or drinking. However, you should refrain from consuming those products that lead to increased gas production. It is advisable to put on compression stockings on your legs, this must be done immediately before the procedure.
FUS-ablation of uterine fibroids
The operation can last up to several hours, the time of each exposure is equal to 20 seconds. Most often, a woman spends up to 4 hours in a doctor's office. At the same time, she is conscious. She lies on her stomach, underneath is a special helium pad. The doctor is in the next room and observes what is happening through the glass and on the monitor. To provide a sedative and analgesic effect, a woman is given special medications through a catheter. In addition to the feeling of warmth in the lower abdomen, the patient does not experience anything else during the procedure.
The waves pass through the tissues of the body and thermally affect the tumor tissue, heating it up to 85 ° C. The impact will continue until the entire tumor has been treated.
The completion of the procedure will be a control scan using MRI.
In order to prevent unforeseen situations, a woman always has a special button in her hand, by pressing which she can stop the procedure. But, as a rule, you don't have to use it. In addition to a slight burning sensation and a slight soreness in the lower back, a woman can not feel anything. If suddenly the patient complains of pain, then the procedure is immediately stopped, the energy and duration of exposure are changed. Thus, the session becomes comfortable again.
The patient will have only a few hours to be under the supervision of doctors. If there are no complications, she goes home. The destruction of the myomatous node itself occurs gradually, but this process is inevitable.
Benefits and contraindications of FUS ablation
Despite the fact that this procedure is quite new, it has already gained popularity.
This happened due to the following advantages:
- Fuzz ablation can be used when the size of the fibroid is quite impressive, as well as with multiple nodules.
- There are no injuries, no scars, no scars on the woman's body.
- This is an absolutely bloodless procedure. The size of the nodes either decreases several times, or they completely dissolve.
- There is no risk of uterine necrosis and inflammation after the procedure.
- The uterus remains in the woman's body, which means that she has the ability to reproduce.
- The possibility of a relapse of the disease is minimized.
- The recovery period does not take long.
- No anesthesia is required during the procedure.
However, in some cases, FUS ablation cannot be performed. This is due to the following factors:
- The woman has metal implants or a pacemaker in her body.
- There are pronounced disorders in the work of the liver, kidneys and cardiovascular system.
- The presence of an intrauterine device in a woman's body until it is removed.
- Contraindications to MRI.
- There are massive scars and scars on the abdominal wall.
- Inflammatory diseases of the pelvic organs in the acute period.
- Body weight exceeding 110 kg, and waist circumference is greater than the same figure.
- Embolization of the uterine arteries, which was performed earlier.
- Severe extragenital pathologies.
Therefore, it is so important that the woman undergoes a thorough examination before the procedure. It should be aimed at clarifying the number of nodes, their size and location. It is important that the node is at least 4 cm from the sacrum so that the sciatic nerves are not damaged. The maximum tumor volume should not exceed 500 cubic centimeters. The nodes themselves should not be more than five pieces. In addition, it will not be possible to perform the procedure if the neoplasm is of the type of submucous or subserous nodes with a pedicle. A contraindication is the location of nodes under multiple bowel loops. In all other cases, the procedure is not contraindicated and is an excellent alternative to surgical interventions.
Complications of FUS-ablation of uterine fibroids
Although the procedure is quite safe, the following complications may occur:
- The appearance of minor thermal burns on the skin is possible (they occur in less than 5% of cases);
- The development of sciatic nerve neuralgia, however, this phenomenon is temporary and, after a short time, it passes;
- Due to the unskilled actions of the doctor, some myomatous tissues may remain untreated, which increases the risk of recurrence;
- Damage to the rectum is possible (less than 1% of cases).
In some cases, it is FUS ablation that is the only procedure that allows you to preserve the possibility of further reproduction.
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Exercises for uterine fibroids according to the method of Bubnovsky
There is another non-surgical way to get rid of uterine fibroids - this is the performance of specialized exercises according to a certain method. The course was developed and compiled by Doctor of Medical Sciences - S. N. Bubnovsky. His exercise system is called kinesitherapy.
The main goal that can be achieved through exercise is the activation of deeply located muscles. They are located either next to, or adjacent to the spine and large joints. As a result, blood circulation increases, blood flow to the organs improves, and they receive more nutrition. The technique also has a positive effect on cartilage tissue.
The professor connects the problem of the development of uterine fibroids precisely with the fact that the pelvic muscles of the floor and perineum do not experience the proper load. Insufficiency and weakness of the muscle mass of the press and lower back also has a negative effect on the disease. Their elaboration in order to have a positive effect on the treatment of fibroids is the main task pursued by modern kinesitherapy.
How did you manage to make such a relationship? It was discovered in the treatment of female patients of the Dr. Bubnovsky Center for osteochondrosis. Often, when undergoing a complete examination for osteochondrosis, a problem such as uterine fibroids was found. After the completion of the rehabilitation course aimed at getting rid of the woman's joint disease, often (not always) resorption of the fibroids located on the uterine wall occurred. Such observations made it possible to draw a parallel between tumor lysis and the positive effect of kinesitherapy on it.
When undergoing a therapeutic course aimed at getting rid of osteochondrosis, the pelvic floor muscles were necessarily involved. It turned out that this helps to eliminate pain, increase blood supply and nutrition to all organs and the disappearance of such a benign tumor as myoma.
In addition, the woman in the shortest possible time managed to get rid of pain, caused not only by osteochondrosis, but also by myoma. As you know, the tumor also causes patients to experience an unpleasant aching or acute pain in the lower abdomen.
The practice of specialists working at the Center of Professor Bubnovsky made it clear that women manage to overcome pain caused not only by the tumor present at the moment, but also after its removal. Most of the patients noticed that the discomfort that did not leave them after the surgical intervention completely disappeared. Most often, positive dynamics is observed after undergoing a course of kinesitherapy for the treatment of the lumbar regions, in which there is an intervertebral hernia. This led to the conclusion that the developed technique works successfully even where other methods of treatment remain powerless. Kinesitherapy beats pain, and this has been proven experimentally.
The specialists working in the clinic noticed that if the tumor is deprived of the possibility of existence in conditions comfortable for its growth and development, then it begins to dissolve. One of the favorable factors for the formation and increase of fibroids in volumes is the passive muscular uterine layer. Having started its active study, it will be possible to activate the body's forces to combat pathology. Physiologists find a rational explanation for this fact. They believe that resorption of the tumor occurs as a result of the activation of phagocytosis, which is positively affected by the active development of the deep muscle layer.
The performed analytical work allowed the specialists of the Professor Bubnovsky Center to single out a separate direction of kinesitherapy. However, this program is only for the prevention of fibroids. There is no need to rely on this complex in advanced cases.
The set of exercises is carried out using exclusive simulators and under the strict supervision of specialists working at the Center.
Women who want to get rid of uterine fibroids without resorting to surgery have plenty to choose from. All three non-surgical methods are available and allow you to effectively and quickly solve the existing problem.
However, it should be borne in mind that uterine artery embolization and FUS ablation can be done in any specialized clinic. While kinesitherapy is available for passage only at the Centers of Professor Bubnovsky and you should only apply there.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
